TY 2022 Form 990

- TIN:

Form990

Department of the TreasuryInternal Revenue Service

Return of Organization Exempt From Income Tax

Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations)

Do not enter social security numbers on this form as it may be made public.

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public Inspection

A For the 2021 calendar year, or tax year beginning 01-01-2022 , and ending 12-31-2022

BCheck if applicable: Address change Name change Initial return Final return/terminated Amended return Application pending

CName of organization
FALLON COMMUNITY HEALTH PLAN INC

% ELIZABETH CREAVIN

Doing business as
FALLON HEALTH

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 province, country, and ZIP or foreign postal code
Worcester, MA01608

D Employer identification number

23-7442369

E Telephone number

G Gross receipts $ 1,904,019,451

F Name and address of principal officer:
TODD BAILEY
10 Chestnut Street
Worcester,MA01608

Tax-exempt status: 501(c)(3) 501(c) ( ) LeftBullet

(insert no.) 4947(a)(1) or 527

Website:

www.fchp.org

H(a)

Is this a group return for
subordinates? Yes No

H(b)

Are all subordinates
included?

Yes No

If "No," attach a list. See instructions.

H(c)

Group exemption number MediumBullet

K Form of organization: Corporation Trust Association Other MediumBullet

L Year of formation: 1975

M State of legal domicile: MA

Part I

Summary

1	Briefly describe the organization’s mission or most significant activities: SEE SCHEDULE O Improving Health and Inspiring Hope
2	Check this box
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	10
5	Total number of individuals employed in calendar year 2021 (Part V, line 2a) ......	5	1,452
6	Total number of volunteers (estimate if necessary) .............	6	0
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	0
b	Net unrelated business taxable income from Form 990-T, Part I, line 11 .........	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	5,000	0
9	Program service revenue (Part VIII, line 2g) .........	1,764,526,148	1,739,420,952
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	11,309,921	7,960,215
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	6,661,325	-37,281
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	1,782,502,394	1,747,343,886
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	809,275	1,056,023
14	Benefits paid to or for members (Part IX, column (A), line 4).....	1,606,086,951	1,564,698,348
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	100,493,821	114,149,739
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	38,979,561	49,136,525
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	1,746,369,608	1,729,040,635
19	Revenue less expenses. Subtract line 18 from line 12.......	36,132,786	18,303,251
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	712,896,484	698,844,489
21	Total liabilities (Part X, line 26).............	407,624,403	442,003,253
22	Net assets or fund balances. Subtract line 21 from line 20.....	305,272,081	256,841,236

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

	Signature of officer	Date

	Type or print name and title

Paid Preparer Use Only

Print/Type preparer's name

Preparer's signature

Date

Check if
self-employed

PTIN

Firm's name MediumBullet

Firm's EIN MediumBullet

Firm's address MediumBullet

Phone no.

May the IRS discuss this return with the preparer shown above? (see instructions) ..........YesNo

For Paperwork Reduction Act Notice, see the separate instructions.

Cat. No. 11282Y Form 990 (2021)

Form 990 (2021)

Page 2

Part III

Statement of Program Service Accomplishments

Check if Schedule O contains a response or note to any line in this Part III..............

Briefly describe the organization’s mission: TO BE THE LEADER IN PROVIDING EXCEPTIONAL COORDINATED CARE AND COVERAGE THAT MEETS THE UNIQUE, DIVERSE AND CHANGING NEEDS OF OUR MEMBERS.

Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ..................... Yes No

If "Yes," describe these new services on Schedule O.

Did the organization cease conducting, or make significant changes in how it conducts, any program
services? ........................... Yes No

If "Yes," describe these changes on Schedule O.

Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations 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 $ 1,542,791,252 including grants of $ ) (Revenue $ 1,708,969,648 )
	SEE SCHEDULE O

4b	(Code: ) (Expenses $ 21,907,097 including grants of $ ) (Revenue $ 30,451,304 )
	SEE SCHEDULE O

4c	(Code: ) (Expenses $ 110,186,951 including grants of $ 1,056,023 ) (Revenue $ )
	SEE SCHEDULE O

4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses1,674,885,300

Form 990 (2021)

Page 3

Part IV

Checklist of Required Schedules

Yes

Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If "Yes," complete Schedule A Click to see attachment

List of Attached Documents:

// Content

.....................

Yes

Is the organization required to complete Schedule B, Schedule of Contributors? See instructions. ...

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 I Click to see attachment

List of Attached Documents:

// Content

.............

Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If "Yes," complete Schedule C, Part II Click to see attachment

List of Attached Documents:

// Content

.........

Yes

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 Rev. Proc. 98-19? If "Yes," complete Schedule C, Part III Click to see attachment

List of Attached Documents:

// Content

Did the organization maintain any donor advised funds or any similar funds or accounts for which 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 I Click to see attachment

List of Attached Documents:

// Content

.........................

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 II Click to see attachment

List of Attached Documents:

// Content

....

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

List of Attached Documents:

// Content

..............

Did the organization report an amount in Part X, line 21 for escrow or custodial account liability; 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 IV Click to see attachment

List of Attached Documents:

// Content

..............

Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi endowments? If "Yes," complete Schedule D, Part V Click to see attachment

List of Attached Documents:

// Content

......

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.

Did the organization report an amount for land, buildings, and equipment in Part X, line 10? If "Yes," complete
Schedule D, Part VI. Click to see attachment

List of Attached Documents:

// Content

...................

11a

Yes

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

List of Attached Documents:

// Content

.......

11b

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

List of Attached Documents:

// Content

.......

11c

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

List of Attached Documents:

// Content

............

11d

Yes

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

List of Attached Documents:

// Content

11e

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

List of Attached Documents:

// Content

11f

12a

Did the organization obtain separate, independent audited financial statements for the tax year? If "Yes," complete
Schedule D, Parts XI and XII Click to see attachment

List of Attached Documents:

// Content

......................

12a

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 and XII is optional Click to see attachment

List of Attached Documents:

// Content

12b

Yes

Is the organization a school described in section 170(b)(1)(A)(ii)? If "Yes," complete Schedule E

14a

Did the organization maintain an office, employees, or agents outside of the United States? .....

14a

Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more? If "Yes," complete Schedule F, Parts I and IV.........

14b

Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or other assistance to or for any foreign organization? If “Yes,” complete Schedule F, Parts II and IV.....

Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or other assistance to or for foreign individuals? If “Yes,” complete Schedule F, Parts III and IV...

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 I. See instructions. ....

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............

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...................

20a

Did the organization operate one or more hospital facilities? If "Yes," complete Schedule H....

20a

If "Yes" to line 20a, did the organization attach a copy of its audited financial statements to this return?

20b

Did the organization report more than $5,000 of grants or other assistance to any domestic organization or domestic government on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II..... Click to see attachment

List of Attached Documents:

// Content

Yes

Form 990 (2021)

Page 4

Part IV

Checklist of Required Schedules (continued)

Yes

Did the organization report more than $5,000 of grants or other assistance to or for domestic individuals on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III........ Click to see attachment

List of Attached Documents:

// Content

Did the organization answer "Yes" to Part VII, Section A, line 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

List of Attached Documents:

// Content

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 lines 24b through 24d and complete Schedule K. If “No,” go to line 25a...............

24a

Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...

24b

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

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), 501(c)(4), and 501(c)(29) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If "Yes," complete Schedule L, Part I ....

25a

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.......................

25b

Did the organization report any amount on Part X, line 5 or 22 for receivables from or payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons? If "Yes," complete Schedule L, Part II...........

Did the organization provide a grant or other assistance to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or employee thereof, a grant selection committee member, or to a 35% controlled entity (including an employee thereof) or family member of any of these persons?

If "Yes," complete

Schedule L, Part III.........................

Was the organization a party to a business transaction with one of the following parties (see the Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):

A current or former officer, director, trustee, key employee, creator or founder, or substantial contributor? If "Yes," complete Schedule L, Part IV......................

28a

A family member of any individual described in line 28a? If "Yes," complete Schedule L, Part IV.....

28b

A 35% controlled entity of one or more individuals and/or organizations described in line 28a or 28b? If "Yes," complete Schedule L, Part IV.....................

28c

Did the organization receive more than $25,000 in non-cash contributions? If "Yes," complete Schedule M..

Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If "Yes," complete Schedule M .................

Did the organization liquidate, terminate, or dissolve and cease operations? If "Yes," complete Schedule N, Part I

Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If "Yes," complete Schedule N, Part II........................

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

List of Attached Documents:

// Content

Yes

Was the organization related to any tax-exempt or taxable entity? If "Yes," complete Schedule R, Part II, III, or IV, and Part V, line 1......................... Click to see attachment

List of Attached Documents:

// Content

Yes

35a

Did the organization have a controlled entity within the meaning of section 512(b)(13)?

35a

Yes

If ‘Yes’ to line 35a, 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

List of Attached Documents:

// Content

35b

Yes

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

List of Attached Documents:

// Content

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 VI Click to see attachment

List of Attached Documents:

// Content

Did the organization complete Schedule O and provide explanations on Schedule O for Part VI, lines 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............

Yes

Part V

Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response or note to any line in this Part V...........

Yes

Enter the number reported in box 3 of Form 1096. Enter -0- if not applicable ..

4,407

Enter the number of Forms W-2G included on line 1a. Enter -0- if not applicable .

Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................

Yes

Form 990 (2021)

Page 5

Part V

Statements Regarding Other IRS Filings and Tax Compliance (continued)

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 ..................

1,452

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.

Yes

Did the organization have unrelated business gross income of $1,000 or more during the year?...

Yes

If “Yes,” has it filed a Form 990-T for this year? If “No” to line 3b, provide an explanation in Schedule O...

Yes

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, securities account, or other financial account)? ..

If "Yes," enter the name of the foreign country: MediumBullet

See instructions for filing requirements for FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR).

Was the organization a party to a prohibited tax shelter transaction at any time during the tax year? ..

Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?

If "Yes," to line 5a or 5b, did the organization file Form 8886-T? ............

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 as charitable contributions? ...

If "Yes," did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible? ......................

Organizations that may receive deductible contributions under section 170(c).

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? ....................

If "Yes," did the organization notify the donor of the value of the goods or services provided? .....

Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282? .........................

If "Yes," indicate the number of Forms 8282 filed during the year ....

Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?

Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract? ..

If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required? ......................

If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C? ..........................

Sponsoring organizations maintaining donor advised funds. Did a donor advised fund maintained by the sponsoring organization have excess business holdings at any time during the year? ........

Sponsoring organizations maintaining donor advised funds.

Did the sponsoring organization make any taxable distributions under section 4966?........

Did the sponsoring organization make a distribution to a donor, donor advisor, or related person?...

Section 501(c)(7) organizations. Enter:

Initiation fees and capital contributions included on Part VIII, line 12 ...

10a

Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities

10b

Section 501(c)(12) organizations. Enter:

Gross income from members or shareholders .........

11a

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

If "Yes," enter the amount of tax-exempt interest received or accrued during the year.

12b

Section 501(c)(29) qualified nonprofit health insurance issuers.

Is the organization licensed to issue qualified health plans in more than one state? .........
Note. See the instructions for additional information the organization must report on Schedule O.

13a

Enter the amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans ....

13b

Enter the amount of reserves on hand ............

13c

14a

Did the organization receive any payments for indoor tanning services during the tax year?.....

14a

If "Yes," has it filed a Form 720 to report these payments? If "No," provide an explanation in Schedule O..

14b

Is the organization subject to the section 4960 tax on payment(s) of more than $1,000,000 in remuneration or excess parachute payment(s) during the year? ....................
If "Yes," see the instructions and file Form 4720, Schedule N.

Yes

Is the organization an educational institution subject to the section 4968 excise tax on net investment income? ..
If "Yes," complete Form 4720, Schedule O.

Section 501(c)(21) organizations. Did the trust, any disqualified person, or mine operator engage in any activities that would result in the imposition of an excise tax under section 4951, 4952, or 4953? ..
If "Yes," complete Form 6069.

Form 990 (2021)

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 or note to any line in this Part VI..............

Section A. Governing Body and Management

Yes

Enter the number of voting members of the governing body at the end of the tax year

If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.

Enter the number of voting members included in line 1a, above, who are independent

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? .................

Yes

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? .

Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? .

Did the organization become aware during the year of a significant diversion of the organization’s assets? .

Did the organization have members or stockholders? ................

Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? ....................

Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ...................

Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:

The governing body? .......................

Yes

Each committee with authority to act on behalf of the governing body? ............

Yes

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.......

Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)

Yes

10a

Did the organization have local chapters, branches, or affiliates? ............

10a

If "Yes," did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes?

10b

11a

Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? ............................

11a

Yes

Describe on Schedule O the process, if any, used by the organization to review this Form 990. .....

12a

Did the organization have a written conflict of interest policy? If "No," go to line 13.......

12a

Yes

Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ..........................

12b

Yes

Did the organization regularly and consistently monitor and enforce compliance with the policy? If "Yes," describe on Schedule O how this was done...................

12c

Yes

Did the organization have a written whistleblower policy? ...............

Yes

Did the organization have a written document retention and destruction policy? .........

Yes

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?

The organization’s CEO, Executive Director, or top management official ...........

15a

Yes

Other officers or key employees of the organization ................

15b

Yes

If "Yes" to line 15a or 15b, describe the process on 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

If "Yes," did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............

16b

Section C. Disclosure

List the states with which a copy of this Form 990 is required to be filed MediumBullet

Section 6104 requires an organization to make its Form 1023 (1024 or 1024-A, if applicable), 990, and 990-T (section 501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.

Own website Another's website Upon request Other (explain in Schedule O)

Describe in Schedule O whether (and if so, how) the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.

State the name, address, and telephone number of the person who possesses the organization's books and records:
MediumBullet

ELIZABETH CREAVIN10 CHESTNUT STREET WORCESTER,MA01608 (508) 799-2100

Form 990 (2021)

Page 7

Part VII

Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors

Check if Schedule O contains a response or note to any line 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. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

List all of the organization’s current key employees, if any. See the instructions for definition of "key employee."

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, Form 1099-MISC, and/or box 1 of Form 1099-NEC) of more than $100,000 from the
organization and any related organizations.

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.

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.

See the instructions for the order in which to list the persons above.

Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee.

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)					(D) Reportable compensation from the organization (W-2/1099-MISC/1099-NEC)	(E) Reportable compensation from related organizations (W-2/1099-MISC/1099-NEC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and title
(1) RICHARD P BURKE...................................................................... PRESIDENT & CEO	44.0 ................. 6.0	X	X				1,419,791	0	738,409
(2) TODD BAILEY...................................................................... SVP, CHIEF FINANCIAL OFFICER	47.0 ................. 3.0		X				607,232	0	221,159
(3) DAVID BRUMLEY MD...................................................................... SVP and Chief Medical Officer	50.0 ................. 0.0			X			495,972	0	231,748
(4) EMILY L WEST...................................................................... SVP, CHIEF OPERATING OFFICER	50.0 ................. 0.0			X			500,698	0	212,897
(5) MARY RITTER...................................................................... SVP, CHIEF STRTGY & GOVT. PROG	49.0 ................. 1.0			X			483,743	0	214,401
(6) JILL GREEN LEBOW...................................................................... SVP, CHIEF HR OFFICER	48.0 ................. 2.0				X		469,876	0	203,754
(7) LINDA WEINREB...................................................................... MEDICAL DIRECTOR, MCD ACO	50.0 ................. 0.0				X		404,566	0	149,693
(8) JAMES GENTILE...................................................................... SVP, CHIEF COMPLIANCE OFFICER	50.0 ................. 0.0				X		379,978	0	156,283
(9) KRISTINE BOSTEK...................................................................... SVP, PACE Programs eff. 5/9/22	49.5 ................. 0.5					X	345,464	0	167,169
(10) RANDI BERKOWITZ...................................................................... VP, Medical Director	50.0 ................. 0.0				X		359,974	0	152,247
(11) MARK DICHTER...................................................................... VP, Medical Director for UM	50.0 ................. 0.0				X		366,512	0	142,667
(12) CHRISTINE CASSIDY...................................................................... SVP, CHIEF COMM. OFFICER	49.5 ................. 0.5					X	352,546	0	154,959
(13) JANIS LIEPINS...................................................................... VP Medicaid	47.0 ................. 3.0					X	347,663	0	155,600
(14) MATTHEW HERNDON...................................................................... SVP, Chief State Prog. Officer	50.0 ................. 0.0			X			308,589	0	173,174
(15) DEBORAH DAVIAU...................................................................... MEDICARE & EXEC. DIR. NAVICARE	50.0 ................. 0.0					X	260,677	0	94,949
(16) KEVIN MCGOVERN...................................................................... VP, TREASURER	50.0 ................. 0.0					X	230,399	0	29,369
(17) FREDERICK MISILO ESQ...................................................................... CHAIR	3.0 ................. 2.0	X	X				46,250	0	0

Form 990 (2021)

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 (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)		(D) Reportable compensation from the organization (W-2/1099-MISC/1099-NEC)	(E) Reportable compensation from related organizations (W-2/1099-MISC/1099-NEC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and title
(18) JOHN B DILL........................................................................ VICE CHAIR	2.0 .......................2.0	X	X	41,000	0	0
(19) JAMES R BUONOMO........................................................................ CLERK	2.0 .......................2.0	X	X	40,250	0	0
(20) JANET S RICO........................................................................ DIRECTOR	1.0 .......................1.0	X		37,750	0	0
(21) DEBORAH C ENOS........................................................................ DIRECTOR	1.0 .......................0.5	X		37,250	0	0
(22) JOSEPH N STOLBERG CPA........................................................................ TREASURER beginning 6/24/22	1.5 .......................0.5	X	X	37,250	0	0
(23) PETER F STRALEY........................................................................ Director	1.0 .......................0.0	X		30,750	0	0
(24) ALICE BONNER........................................................................ DIRECTOR	1.0 .......................0.0	X		28,250	0	0
(25) VICTOR WOOLRIDGE........................................................................ DIRECTOR	1.0 .......................0.0	X		24,750	0	0
(26) WANDA J MCCLAIN........................................................................ DIRECTOR	1.0 .......................0.0	X		24,750	0	0
(27) ANN K TRIPP........................................................................ TREASURER ended 6/24/22	2.0 .......................2.0	X	X	8,250	0	0
(28) KARIN LANDRY........................................................................ Director ended 6/24/22	1.0 .......................0.0	X		6,750	0	0

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	7,657,180	0	3,198,478

Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organization MediumBullet

296

Yes

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 ..............

Yes

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...........................

Yes

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 ........

Section B. Independent Contractors

Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.

(A) Name and business address	(B) Description of services	(C) Compensation
EPSTEIN BECKER AND GREEN PC, 1227 25TH ST NW STE 700 WASHINGTON,DC20037	Legal Services	1,506,945
SAFEWAY LUXURY TRANSPORTATION, 112 GROVE ST REAR WORCESTER,MA01605	Transportation Servi	1,287,280
CHANGE HEALTHCARE LLC, 5995 WINDWARD PARKWAY ALPHARETTA,GA30005	Healthcare Consultin	1,069,973
CDW DIRECT LLC, PO BOX 75723 CHICAGO,IL60675	Technology products	992,106
MDX MEDICAL LLC, 160 CHUBB AVE STE 301 ACCOUNTS RECE LYNDHURST,NJ07071	Healthcare Software	711,150
2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 34

Form 990 (2021)

Page 9

Part VIII

Statement of Revenue

Check if Schedule O contains a response or note to any line in this Part VIII.............

(A)
Total revenue

(B)
Related or
exempt
function
revenue

(D)
Revenue
excluded from
tax under sections
512 - 514

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d
e	Government grants (contributions)		1e

f	All other contributions, gifts, grants, and similar amounts not included above		1f

g	Noncash contributions included in lines 1a - 1f:$		1g

h Total. Add lines 1a-1f.......		0

		Business Code
2a	PREMIUM-GOVERNMENTAL	524114	1,708,969,648	1,708,969,648	0	0
b	PREMIUM-COMMERCIAL	524114	30,451,304	30,451,304	0	0
c
d
e
f	All other program service revenue.
g	Total. Add lines 2a–2f .....		1,739,420,952

3 Investment income (including dividends, interest, and othersimilar amounts) ......			14,216,018	0	0	14,216,018
4 Income from investment of tax-exempt bond proceeds			0
5 Royalties...........			0
		(ii) Personal	(i) Real
6a	Gross rents		61,030	6a
b	Less: rental expenses		61,030	6b
c	Rental income or (loss)	0	0	6c
d	Net rental income or (loss).......			0	0	0	0
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory		150,358,732	7a
b	Less: cost or other basis and sales expenses		156,614,535	7b
c	Gain or (loss)		-6,255,803	7c
d	Net gain or (loss).........			-6,255,803	0	0	-6,255,803
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
			8a	0
b	Less: direct expenses ...		8b	0
c	Net income or (loss) from fundraising events..			0
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a	0
b	Less: direct expenses ...		9b	0
c	Net income or (loss) from gaming activities..			0
10a	Gross sales of inventory, less returns and allowances ..
			10a	0
b	Less: cost of goods sold ..		10b	0
c	Net income or (loss) from sales of inventory..			0
Business Code			Miscellaneous Revenue
11a	SUBSIDIARY LOSS/GAIN		524298	-925,355	0	0	-925,355
b	MINORITY INTEREST		900099	725,886	0	0	725,886
c	CLASS ACTION LAWSUIT & MISC.		900099	157,188	0	0	157,188
d	All other revenue ....			5,000	0	0	5,000
e	Total. Add lines 11a–11d ......			-37,281
12	Total revenue. See instructions.....			1,747,343,886	1,739,420,952	0	7,922,934

Form 990 (2021)

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).Check if Schedule O contains a response or note to any line in this Part IX..............

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 domestic organizations and domestic governments. See Part IV, line 21 ....	1,056,023	1,056,023
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........	0
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............	0
4	Benefits paid to or for members .......	1,564,698,348	1,564,698,348
5	Compensation of current officers, directors, trustees, and key employees ...........	5,971,062	3,897,429	2,073,633	0
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .........	3,414,266	2,373,325	1,040,941	0
7	Other salaries and wages........	84,365,919	58,644,445	25,721,474	0
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	1,277,727	888,174	389,553	0
9	Other employee benefits .......	10,932,757	7,599,579	3,333,178	0
10	Payroll taxes ...........	8,188,008	5,691,649	2,496,359	0
11	Fees for services (non-employees):
a	Management ......	0
b	Legal .........	2,224,548	0	2,224,548	0
c	Accounting ...........	1,607,784	0	1,607,784	0
d	Lobbying ...........	159,447	159,447	0	0
e	Professional fundraising services. See Part IV, line 17	0
f	Investment management fees ......	1,115,996	0	1,115,996	0
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	7,501,212	5,559,143	1,942,069
12	Advertising and promotion ....	3,064,935	2,389,801	675,134	0
13	Office expenses .......	5,897,003	4,598,031	1,298,972	0
14	Information technology ......	16,663,168	15,682,589	980,579	0
15	Royalties ..	0
16	Occupancy ...........	4,249,042	235,672	4,013,370	0
17	Travel ............	68,369	53,309	15,060	0
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .	0
19	Conferences, conventions, and meetings ....	312,179	243,413	68,766	0
20	Interest ...........	109,477	0	109,477	0
21	Payments to affiliates .......	0
22	Depreciation, depletion, and amortization ..	3,940,950	148,621	3,792,329	0
23	Insurance ...	1,037,359	0	1,037,359	0
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	DUES/SUBSCRIPTIONS	1,075,923	963,247	112,676	0
b	OTHER TAXES	106,078	0	106,078	0
c	BAD DEBT EXPENSES	3,055	3,055	0	0
d
e	All other expenses
25	Total functional expenses. Add lines 1 through 24e	1,729,040,635	1,674,885,300	54,155,335	0
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

Form 990 (2021)

Page 11

Part X

Balance Sheet

Check if Schedule O contains a response or note to any line in this Part IX..............

				(A) Beginning of year		(B) End of year

1	Cash–non-interest-bearing ........			0	1	0
2	Savings and temporary cash investments .........			90,085,889	2	60,971,299
3	Pledges and grants receivable, net ......			0	3	0
4	Accounts receivable, net .............			92,139,634	4	129,743,675
5	Loans and other receivables from any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
				0	5	0
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
				0	6	0
7	Notes and loans receivable, net ...........			0	7	0
8	Inventories for sale or use ............			0	8	0
9	Prepaid expenses and deferred charges ......			5,976,350	9	6,665,677
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	44,900,509
b	Less: accumulated depreciation	10b	36,211,725	10,493,215	10c	8,688,784
11	Investments—publicly traded securities .			480,290,667	11	439,738,109
12	Investments—other securities. See Part IV, line 11 .....			0	12	0
13	Investments—program-related. See Part IV, line 11 ..			0	13	0
14	Intangible assets ...............			0	14	0
15	Other assets. See Part IV, line 11 ...........			33,910,729	15	53,036,945
16	Total assets. Add lines 1 through 15 (must equal line 33)...			712,896,484	16	698,844,489

17	Accounts payable and accrued expenses .....	401,392,953	17	440,783,190
18	Grants payable ...	0	18	0
19	Deferred revenue .........	6,231,450	19	1,220,063
20	Tax-exempt bond liabilities .........	0	20	0
21	Escrow or custodial account liability. Complete Part IV of Schedule D	0	21	0
22	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
		0	22	0
23	Secured mortgages and notes payable to unrelated third parties ..	0	23	0
24	Unsecured notes and loans payable to unrelated third parties ..	0	24	0
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17 - 24). Complete Part X of Schedule D	0	25	0
26	Total liabilities. Add lines 17 through 25..	407,624,403	26	442,003,253

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........	305,272,081	27	256,841,236
28	Net assets with donor restrictions ...........	0	28	0
	Organizations that do not follow FASB ASC 958, check here and complete lines 29 through 33.
29	Capital stock or trust principal, or current funds .....		29
30	Paid-in or capital surplus, or land, building or equipment fund ...		30
31	Retained earnings, endowment, accumulated income, or other funds		31
32	Total net assets or fund balances ...........	305,272,081	32	256,841,236
33	Total liabilities and net assets/fund balances ........	712,896,484	33	698,844,489

Form 990 (2021)

Page 12

Part XI

Reconcilliation of Net Assets

Check if Schedule O contains a response or note to any line in this Part XI..............

Total revenue (must equal Part VIII, column (A), line 12) ............

1,747,343,886

Total expenses (must equal Part IX, column (A), line 25) ............

1,729,040,635

Revenue less expenses. Subtract line 2 from line 1 ..............

18,303,251

Net assets or fund balances at beginning of year (must equal Part X, line 32, column (A)) ..

305,272,081

Net unrealized gains (losses) on investments ...............

-66,734,096

Donated services and use of facilities .................

Investment expenses .....................

Prior period adjustments .....................

Other changes in net assets or fund balances (explain in Schedule O) ........

Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 32, column (B))

256,841,236

Part XII

Financial Statements and Reporting

Check if Schedule O contains a response or note to any line in this Part XII.............

Yes

Accounting method used to prepare the Form 990: Cash Accrual Other
If the organization changed its method of accounting from a prior year or checked "Other," explain on
Schedule O.

Were the organization’s financial statements compiled or reviewed by an independent accountant?

If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:

Separate basis Consolidated basis Both consolidated and separate basis

Were the organization’s financial statements audited by an independent accountant?

Yes

If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:

Separate basis Consolidated basis Both consolidated and separate basis

If "Yes," to line 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?

Yes

If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.

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?

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.

Form 990 (2021)

Additional Data

Software ID:
Software Version:

Form 990, Special Condition Description:

Special Condition Description

- TIN:

SCHEDULE A
(Form 990)

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

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2022

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 12, check only one box.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990).)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An agricultural research organization described in 170(b)(1)(A)(ix) operated in conjunction with a land-grant college or university or a non-land grant college of agriculture. See instructions. Enter the name, city, and state of the college or university:

An organization that normally receives: (1) more than 33 1/3% of its support from contributions, membership fees, and gross receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 33 1/3% 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.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box on lines 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations ...............................

Provide the following information about the supported organization(s).

(i) Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i) Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


Total

For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.

Cat. No. 11285F

Schedule A (Form 990) 2022

Page 2

Part II

Support Schedule for Organizations Described in Sections 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 failed to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2018	(b) 2019	(c) 2020	(d) 2021	(e) 2022	(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.

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2018	(b) 2019	(c) 2020	(d) 2021	(e) 2022	(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

Gross receipts from related activities, etc. (see instructions) ..................

First 5 years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here ........................................ right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2022 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2020 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2022. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2021. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2022. If the organization did not check a box on line 13, 16a, or 16b, and line 14 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported organization ............ right arrow

10%-facts-and-circumstances test—2021. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line 15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported organization ............ right arrow

Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow

Schedule A (Form 990) 2022

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 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) 2018	(b) 2019	(c) 2020	(d) 2021	(e) 2022	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .	125,589	0	0	5,000	0	130,589
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	1,514,381,036	1,569,180,946	1,629,023,510	1,764,526,148	1,739,420,952	8,216,532,592
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	0	0
5	The value of services or facilities furnished by a governmental unit to the organization without charge				0	0	0
6	Total. Add lines 1 through 5	1,514,506,625	1,569,180,946	1,629,023,510	1,764,531,148	1,739,420,952	8,216,663,181
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.	66,679,504	27,794,779	33,713,513	29,157,740	19,369,922	176,715,458
c	Add lines 7a and 7b..	66,679,504	27,794,779	33,713,513	29,157,740	19,369,922	176,715,458
8	Public support. (Subtract line 7c from line 6.)						8,039,947,723

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2018	(b) 2019	(c) 2020	(d) 2021	(e) 2022	(f) Total
9	Amounts from line 6...	1,514,506,625	1,569,180,946	1,629,023,510	1,764,531,148	1,739,420,952	8,216,663,181
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..	7,966,759	9,252,715	9,017,324	10,580,261	14,277,048	51,094,107
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.						0
c	Add lines 10a and 10b.	7,966,759	9,252,715	9,017,324	10,580,261	14,277,048	51,094,107
11	Net income from unrelated business activities not included on 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 VI.) ..	155,409	152,170	270,778	54,056	162,188	794,601
13	Total support. (Add lines 9, 10c, 11, and 12.)..	1,522,628,793	1,578,585,831	1,638,311,612	1,775,165,465	1,753,860,188	8,268,551,889

First 5 years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here................................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2022 (line 8, column (f) divided by line 13, column (f)) .........

97.235 %

Public support percentage from 2021 Schedule A, Part III, line 15 ...............

96.121 %

Section D. Computation of Investment Income Percentage

Investment income percentage for 2022 (line 10c, column (f) divided by line 13, column (f)) ......

0.618 %

Investment income percentage from 2021 Schedule A, Part III, line 17 .............

0.567 %

19a

33 1/3% support tests-2022. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow

33 1/3% support tests—2021. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ..... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions .... right arrow

Schedule A (Form 990) 2022

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked box 12a, of Part I, complete Sections A and B. If you checked box 12b, of Part I, complete Sections A and C. If you checked box 12c, of Part I, complete Sections A, D, and E. If you checked box12d, of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.

Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer lines 3b and 3c below.

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked box 12a or 12b in Part I, answer lines 4b and 4c below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.

Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer lines 5b and 5c below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described on line 7? If “Yes,” complete Part I of Schedule L (Form 990).

Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons, as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined on line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined on line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).

10b

Schedule A (Form 990) 2022

Page 5

Part IV

Supporting Organizations (continued)

Yes

Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described on lines 11b and 11c below, the governing body of a supported organization?

11a

A family member of a person described on 11a above?

11b

A 35% controlled entity of a person described on line 11a or 11b above? If “Yes” to 11a, 11b, or 11c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the officers, directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).

By reason of the relationship described in line 2 above, did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer lines 2a and 2b below.

Yes

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

Did the activities described on line 2a, above constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

Parent of Supported Organizations. Answer lines 3a and 3b below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations?If "Yes" or "No", provide details in Part VI.

Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.

Schedule A (Form 990) 2022

Page 6

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970 (explain in Part VI). See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	Section A - Adjusted Net Income		(A) Prior Year	(B) Current Year (optional)
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)
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):
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

Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990) 2022

Page 7

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations(continued)

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 2022 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-2022	(iii) Distributable Amount for 2022
1 Distributable amount for 2022 from Section C, line 6
2 Underdistributions, if any, for years prior to 2022 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2022:
a From 2017.......
b From 2018.......
c From 2019.......
d From 2020.......
e From 2021.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2022 distributable amount
i Carryover from 2017 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from line 3f.
4Distributions for 2022 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2022 distributable amount
c Remainder. Subtract lines 4a and 4b from line 4.
5 Remaining underdistributions for years prior to 2022, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions.
6 Remaining underdistributions for 2022. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions.
7 Excess distributions carryover to 2023. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2018.....
b Excess from 2019.....
c Excess from 2020.....
d Excess from 2021.....
e Excess from 2022.....

Schedule A (Form 990) (2022)

Schedule A (Form 990) 2022

Page 8

Part VI

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Return Reference	Explanation
SUPPORT TEST	FORM 990, SCHEDULE A, PART III THE ORGANIZATION'S IRS DETERMINATION LETTER INDICATES THAT THIS ORGANIZATION QUALIFIES AS A PUBLICLY SUPPORTED CHARITY 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) 2022

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990)

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

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public
Inspection

If the organization answered "Yes" on 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" on 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" on Form 990, Part IV, Line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), 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.

Provide a description of the organization’s direct and indirect political campaign activities in Part IV. See instructions for definition of “political campaign activities."

Political campaign activity expenditures. See instructions .................................................................... SchCMd Bullet

Volunteer hours for political campaign activities. See instructions ..................................................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ................................ SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ....................... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? .........................................

Yes No

Was a correction made? ......................................................................................................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c), except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities ..... SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ............................................................................................................................ SchCMd Bullet

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

Did the filing organization file Form 1120-POL for this year? ...................................................................

Yes No

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-.
1
2
3
4
5
6

For Paperwork Reduction Act Notice, see the instructions for Form 990.

Cat. No. 50084S

Schedule C (Form 990) 2021

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 SchCMd Bullet

if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet

if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(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? ...................................................................................................................	Yes No

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 separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2018	(b) 2019	(c) 2020	(d) 2021	(e) Total

2a	Lobbying nontaxable amount

b	Lobbying ceiling amount (150% of line 2a, column(e))

c	Total lobbying expenditures

d	Grassroots nontaxable amount

e	Grassroots ceiling amount (150% of line 2d, column (e))

f	Grassroots lobbying expenditures

Schedule C (Form 990) 2021

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)).

For each "Yes" response on lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes|No

(b)

Amount

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:

Volunteers? ...........................................................................................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ........

Yes

Media advertisements? ...................................................................................................

Mailings to members, legislators, or the public? .............................................................................

Publications, or published or broadcast statements? ...........................................................

Grants to other organizations for lobbying purposes? ..........................................................

Direct contact with legislators, their staffs, government officials, or a legislative body? .......................

Yes

225,544

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ..................

Other activities? ...................................................................................................................

Total. Add lines 1c through 1i ....................................................................................................

225,544

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 ...........................................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 ...................

If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? ........................

Part III-A

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).

Yes

Were substantially all (90% or more) dues received nondeductible by members? ...............................................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ............................................

Did the organization agree to carry over lobbying and political expenditures from the prior year? .................................

Part III-B

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."

Dues, assessments and similar amounts from members ......................................................................

Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political expenses for which the section 527(f) tax was paid).

Current year .............................................................................................................................

Carryover from last year ............................................................................................................

Total ...........................................................................................................................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

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? ......................................................................................................................

Taxable amount of lobbying and political expenditures. See Instructions .........................................

Part IV

Supplemental Information

Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.

Return Reference	Explanation
Direct Lobbying Expense	FORM 990, SCHEDULE C, PART IV SUPPLEMENTAL INFORMATION: FCHP PAID A TOTAL OF $225,544 LOBBYING EXPENSES AS FOLLOWS: MAHP DUES (MASS ASSOC OF HEALTH PLANS) 72,846 ASSOCIATION FOR COMM AFFILIATED PLANS 5,075 NATIONAL PACE ASSOCIATION 3,430 ALLIANCE OF COMMUNITY HEALTH PLANS 61,740 MASSPACE INC 16,356 ----------- SUBTOTAL NON-EMPLOYEES $159,447 STAFF SALARIES ASSOCIATED WITH LOBBYING 66,097 ------------ TOTAL OF ALL LOBBYING EXPENSES PAID $225,544 IN 2022, FALLON STAFF ENGAGED WITH VERIOUS REGULATORY AGENCIES ON HEALTHCARE POLICIES.

Return Reference

Explanation

Direct Lobbying Expense

FORM 990, SCHEDULE C, PART IV SUPPLEMENTAL INFORMATION: FCHP PAID A TOTAL OF $225,544 LOBBYING EXPENSES AS FOLLOWS: MAHP DUES (MASS ASSOC OF HEALTH PLANS) 72,846 ASSOCIATION FOR COMM AFFILIATED PLANS 5,075 NATIONAL PACE ASSOCIATION 3,430 ALLIANCE OF COMMUNITY HEALTH PLANS 61,740 MASSPACE INC 16,356 ----------- SUBTOTAL NON-EMPLOYEES $159,447 STAFF SALARIES ASSOCIATED WITH LOBBYING 66,097 ------------ TOTAL OF ALL LOBBYING EXPENSES PAID $225,544 IN 2022, FALLON STAFF ENGAGED WITH VERIOUS REGULATORY AGENCIES ON HEALTHCARE POLICIES.

Schedule C (Form 990) 2021

Additional Data

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SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," on Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
SchDMd Bullet

Attach to Form 990.
SchDMd Bullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

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" on Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .........
2	Aggregate value of contributions to (during year)
3	Aggregate value of grants from (during year)
4	Aggregate value at end of year ........

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? ............

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can 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? ...................................

Yes No

Part II

Conservation Easements.
Complete if the organization answered "Yes" on Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax 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 7/25/06, and not on a historic structure listed in the National Register ...	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .............................

Yes No

In Part XIII, 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" on Form 990, Part IV, line 8.

If the organization elected, as permitted under FASB ASC 958, 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 XIII, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under FASB ASC 958, 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)

Revenue included on Form 990, Part VIII, line 1 ......................... SchDMd Bullet

(ii)

Assets included in Form 990, Part X ............................... SchDMd Bullet

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 FASB ASC 958 relating to these items:

Revenue included on Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 52283D

Schedule D (Form 990) 2021

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

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?...

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No


b	If "Yes," explain the arrangement in Part XIII 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

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? ...

Yes No

If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ....

Part V

Endowment Funds.
Complete if the organization answered "Yes" on 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	Net investment earnings, gains, and losses
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...
f	Administrative expenses ....
g	End of year balance ......

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

Term endowment SchDMd Bullet

The percentages on lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) Unrelated organizations .................

3a(i)

(ii) Related organizations .................

3a(ii)

If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........

Describe in Part XIII the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.

Description of property		(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	1,890,814	1,578,593	312,221
d	Equipment ....	7,681,407	5,705,939	1,975,468
e	Other .....	35,328,288	28,927,193	6,401,095
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				8,688,784

Schedule D (Form 990) 2021

Page 3

Part VII

Investments - Other Securities.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11b. 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........
(3)Other
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

Investments - Program Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

(a) Description of investment	(b) Book value	(c) Method of valuation: Cost or end-of-year market value

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value
(1)INVESTMENT IN FHLAC				20,615,074
(2)INVESTMENT IN FTC				434,636
(3)INVESTMENT IN FHW				12,661,550
(4)OPERATING LEASE ROU ASSET				19,325,685
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				53,036,945

Part X

Other Liabilities.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability	(b) Book value
(1) Federal income taxes

(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)
2. Liability for uncertain tax positions. In Part XIII, 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 (ASC 740). Check here if the text of the footnote has been provided in Part XIII

Schedule D (Form 990) 2021

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......		1
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d .....................		2e
3	Subtract line 2e from line 1..................		3
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
b	Other (Describe in Part XIII.) ...........	4b
c	Add lines 4a and 4b....................		4c
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......		5

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........		1
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 XIII.) ............	2d
e	Add lines 2a through 2d....................		2e
3	Subtract line 2e from line 1...................		3
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
b	Other (Describe in Part XIII.) ............	4b
c	Add lines 4a and 4b.....................		4c
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......		5

Part XIII

Supplemental Information

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, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Return Reference	Explanation

Schedule D (Form 990) 2021

Additional Data

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Note: To capture the full content of this document, please select landscape mode (11" x 8.5") when printing.

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," on Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990.
lBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2022

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

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? ........................

Yes No

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 Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on Form 990, Part IV, line 21, for any recipient

that received more than $5,000. Part II can be duplicated if additional space is needed.

(a) Name and address of organization or government	(b) EIN	(c) IRC 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 noncash assistance	(h) Purpose of grant or assistance
(1) Worcester Regional Chamber of Commerce 311 Main St Ste 200 Worcester,MA01608	04-1988780	501(c)(6)	47,050				GENERAL SUPPORT
(2) WORCESTER COUNTY FOOD BANK 474 BOSTON TURNPIKE SHREWSBURY,MA01545	04-3071457	501(C)(3)	59,500				GENERAL SUPPORT
(3) Boys and Girls Club of Worcester 65 BoysGirls Club Way Worcester,MA01610	04-2105851	501(c)(3)	49,039				GENERAL SUPPORT
(4) United Way of Central MA 18 Chestnut St Ste 530 Worcester,MA01608	04-2104017	501(C)(3)	30,831				GENERAL SUPPORT
(5) Worcester Regional Research Bureau 390 Main St Ste 208 WORCESTER,MA01609	04-2901298	501(C)(3)	7,000				GENERAL SUPPORT
(6) MERRIMACK VALLEY FOOD BANK INC 735 Broadway Street LOWELL,MA01854	22-3241609	501(C)(3)	17,500				GENERAL SUPPORT
(7) CENTRAL MA HOUSING ALLIANCE 6 INSTITUTE ROAD WORCESTER,MA01609	04-2791448	501(C)(3)	14,500				GENERAL SUPPORT
(8) HEYWOOD MEMORIAL HOSPITAL 242 GREEN STREET Gardner,MA01440	04-2103581	501(C)(3)	25,000				GENERAL SUPPORT
(9) RON BURTON TRAINING VILLAGE 55 MORGAN RD HUBBARDSTON,MA01452	22-2570218	501(C)(3)	25,000				GENERAL SUPPORT
(10) Saint Paul's Elder Outreach 19 Chatham Street Worcester,MA01609	04-2106744	501(C)(3)	17,749				GENERAL SUPPORT
(11) PERNET FAMILY HEALTH SERVICES INC 237 Millbury Street WORCESTER,MA01610	04-2453851	501(C)(3)	9,000				GENERAL SUPPORT
(12) VETERANS INC 69 Grove Street WORCESTER,MA01605	04-3098024	501(C)(3)	11,548				GENERAL SUPPORT
(13) Worcester Hibernian Cultural Foundation 19 Temple Street Worcester,MA01604	20-2148447	501(C)(3)	12,000				GENERAL SUPPORT
(14) ELDER SERVICES OF BERKSHIRE COUNTY INC 877 South St Ste 4E Pittsfield,MA01201	04-2542001	501(C)(3)	10,000				GENERAL SUPPORT
(15) Community Harvest Project 37 Wheeler Road North Grafton,MA01536	04-3424018	501(C)(3)	19,500				GENERAL SUPPORT
(16) THE HEALTH FOUNDATION INC 664 Main St fl 20 WORCESTER,MA01608	04-2633274	501 (C)(4)	25,000				GENERAL SUPPORT
(17) Be Like Brit Foundation 66 Pullman Street Worcester,MA01606	27-1857525	501(c)(3)	6,000				GENERAL SUPPORT
(18) Boston Area Gleaners Inc 91 Martin Street Acton,MA01720	30-0434755	501(c)(3)	10,000				GENERAL SUPPORT
(19) Catholic Charities 10 Hammond Street Worcester,MA01610	04-2103979	501(c)(3)	31,547				GENERAL SUPPORT
(20) Cheshire Pantry PO Box K Cheshire,MA01225	84-2607415	501(c)(3)	7,000				GENERAL SUPPORT
(21) City of Worcester 75 Lovell Street Worcester,MA01603	04-6001418	501(c)(3)	2,500	7,460	FMV	FURNITURE DONATION	GENERAL SUPPORT
(22) Coastline Elderly Services Inc 863 Belleville Avenue New Bedford,MA02745	04-2622121	501(c)(3)	12,760				GENERAL SUPPORT
(23) Discover Central MA 311 Main Street Worcester,MA01608	47-4881059	501(c)(6)	25,000				GENERAL SUPPORT
(24) D'Youville Life and Wellness Community 981 Varnum Avenue Lowell,MA01879	91-2055004	501(c)(3)	5,250				GENERAL SUPPORT
(25) Edward M Kennedy Health Care Center	04-2513817	501(c)(3)	16,450				GENERAL SUPPORT
(26) El Buen Samaritano Food Program 39 Piedmont Street Worcester,MA01610	04-3117161	501(c)(3)	16,500				GENERAL SUPPORT
(27) Family Health Center Worcester 26 Queen Street Worcester,MA01610	04-2485308	501(c)(3)	10,500				GENERAL SUPPORT
(28) Food Link Inc 108 Summer Street Arlington,MA02474	47-1840355	501(c)(3)	10,000				GENERAL SUPPORT
(29) Friendly House 36 Wall Street Worcester,MA01604	04-2104239	501(c)(3)	10,000				GENERAL SUPPORT
(30) Growing Places 325 Lindell Avenue Leominster,MA01453	10-0004885	501(c)(3)	15,000				GENERAL SUPPORT
(31) Latin American Business Organization (LABO) 33 Highland Street Worcester,MA01602	81-0824363	501(c)(3)	7,000				GENERAL SUPPORT
(32) Lorraine's Soup Kitchen 170 Pendexter Avenue Chicopee,MA01013	04-2616751	501(c)(3)	7,500				GENERAL SUPPORT
(33) Lovin' Spoonfuls 189 Wells Avenue Newton,MA02459	27-1810597	501(c)(3)	10,000				GENERAL SUPPORT
(34) Massachusetts Taxpayers Foundation 333 Washington St Ste 853 Boston,MA02108	04-1590310	501(c)(3)	7,000				GENERAL SUPPORT
(35) Mustard Seed Catholic Worker Community Inc 93 Piedmont Street Worcester,MA01609	47-3600849	501(c)(3)	7,000				GENERAL SUPPORT
(36) Nativity School of Worcester 67 Lincoln Street Worcester,MA01605	03-0385377	501(c)(3)	19,902				GENERAL SUPPORT
(37) Net of Compassion Corp 674 Main Street Worcester,MA01610	47-5387634	501(c)(3)	5,500				GENERAL SUPPORT
(38) Open Sky Community Services Inc 4 Mann Street Worcester,MA01602	04-2587863	501(c)(3)	95,500				GENERAL SUPPORT
(39) Pakachoag School Auburn 203 Pakachoag Street Auburn,MA01501	04-3029253	501(c)(3)		5,850	FMV	FURNITURE	FURNITURE DONATION
(40) Southeast Asian Coalition 484 Main St Ste 400 Worcester,MA01608	04-3393955	501(c)(3)	28,793				GENERAL SUPPORT
(41) The Journey Community Church 27 Belmont Street Worcester,MA01605	46-4261664	501(c)(3)	9,000				GENERAL SUPPORT
(42) The Nutrition Center (fiscal agent for Western MA 205 N Plain Rd Great Barrington,MA01230	06-1812530	501(c)(3)	9,500				GENERAL SUPPORT
(43) The Open Pantry of Greater Lowell 13 Hurd St Lowell,MA01852	22-2474729	501(c)(3)	8,500				GENERAL SUPPORT
(44) United Way of Tri-County 46 Park Street Framingham,MA01702	04-2104231	501(c)(3)	20,000				GENERAL SUPPORT
(45) Why Me 1152 Pleasant Street Worcester,MA01602	04-2880644	501(c)(3)	14,416				GENERAL SUPPORT
(46) WooSox Foundation 100 Madison Street Worcester,MA01608	84-4493574	501(c)(3)	7,000				GENERAL SUPPORT
(47) Worcester Center for Performing Arts (the Hanover 2 Southbridge St Worcester,MA01608	05-0521735	501(c)(3)	6,700				GENERAL SUPPORT
(48) Worcester Community Action Council 18 Chestnut St Ste 500 Worcester,MA01608	04-2382160	501(c)(3)	4,500	5,248	FMV	FURNITURE	GENERAL SUPPORT
(49) Worcester County Senior Athletic Association 13 Harberton Dr Leicester,MA01524	82-0713031	501(c)(3)	5,500				GENERAL SUPPORT
(50) Worcester Railers HC Charitable Foundation 112 Harding Street Worcester,MA01604	81-1645767	501(c)(3)	9,000				GENERAL SUPPORT
(51) Yes We Care 55 Illinois Street Worcester,MA01610	27-2939066	501(c)(3)	10,000				GENERAL SUPPORT

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image

Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50055P

Schedule I (Form 990) 2022

Page 2

Part III

Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.

(a) Type of grant or assistance	(b) Number of recipients	(c) Amount of cash grant	(d) Amount of noncash assistance	(e) Method of valuation (book, FMV, appraisal, other)	(f) Description of noncash assistance

(1)
(2)
(3)
(4)
(5)
(6)
(7)

Part IV

Supplemental Information. Provide the information required in Part I, line 2; Part III, column (b); and any other additional information.

Return Reference

Explanation

Form 990, Schedule I, PART I, LINE 2

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 FCHP GRANT HAS SPECIFIC INSTRUCTIONS TO BE FOLLOWED AS TO THE USE OF THE 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 REVIEWED AND KEPT ON FILE AT FCHP.

Schedule I (Form 990) 2022

Additional Data

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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" on Form 990, Part IV, line 23.
SchJMediumBullet

Attach to Form 990.
SchJMediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2022

Open to Public Inspection

Name of the organization

FALLON COMMUNITY HEALTH PLAN INC

Employer identification number

23-7442369

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes on Line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain .....

Yes

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked on Line 1a? ....

Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed on Form 990, Part VII, Section A, line 1a, with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? .............

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Yes

Participate in, or receive payment from, an equity-based compensation arrangement? .........

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), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ....................

Any related organization? .......................

If "Yes," on line 5a or 5b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization? ..................

Any related organization? ......................

If "Yes," on line 6a or 6b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any nonfixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Yes

Were any amounts reported on Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III ..........................

Yes

If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

Yes

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50053T

Schedule J (Form 990) 2022

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.

For each individual whose compensation must be reported on 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) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.

(A) Name and Title		(B) Breakdown of W-2, 1099-MISC compensation, and/or 1099-NEC			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation in column (B) reported as deferred on prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1CHRISTINE CASSIDY SVP, CHIEF COMM. OFFICER	(i) (ii)	263,383 ------------- 0	65,856 ------------- 0	23,307 ------------- 0	127,113 ------------- 0	27,846 ------------- 0	507,505 ------------- 0	85,314 ------------- 0
2DAVID BRUMLEY MD SVP and Chief Medical Officer	(i) (ii)	423,343 ------------- 0	67,814 ------------- 0	4,815 ------------- 0	190,248 ------------- 0	41,500 ------------- 0	727,720 ------------- 0	67,814 ------------- 0
3DEBORAH DAVIAU MEDICARE & EXEC. DIR. NAVICARE	(i) (ii)	220,167 ------------- 0	38,188 ------------- 0	2,322 ------------- 0	77,033 ------------- 0	17,916 ------------- 0	355,626 ------------- 0	38,188 ------------- 0
4EMILY L WEST SVP, CHIEF OPERATING OFFICER	(i) (ii)	391,235 ------------- 0	97,403 ------------- 0	12,060 ------------- 0	184,475 ------------- 0	28,422 ------------- 0	713,595 ------------- 0	97,403 ------------- 0
5JAMES GENTILE SVP, CHIEF COMPLIANCE OFFICER	(i) (ii)	286,639 ------------- 0	70,814 ------------- 0	22,525 ------------- 0	139,222 ------------- 0	17,061 ------------- 0	536,261 ------------- 0	90,557 ------------- 0
6JANIS LIEPINS VP Medicaid	(i) (ii)	280,912 ------------- 0	59,893 ------------- 0	6,858 ------------- 0	121,200 ------------- 0	34,400 ------------- 0	503,263 ------------- 0	59,893 ------------- 0
7JILL GREEN LEBOW SVP, CHIEF HR OFFICER	(i) (ii)	351,689 ------------- 0	92,927 ------------- 0	25,260 ------------- 0	165,921 ------------- 0	37,833 ------------- 0	673,630 ------------- 0	116,952 ------------- 0
8KEVIN MCGOVERN VP, TREASURER	(i) (ii)	175,322 ------------- 0	52,884 ------------- 0	2,193 ------------- 0	10,400 ------------- 0	18,969 ------------- 0	259,768 ------------- 0	52,884 ------------- 0
9KRISTINE BOSTEK SVP, PACE Programs eff. 5/9/22	(i) (ii)	286,490 ------------- 0	57,574 ------------- 0	1,400 ------------- 0	129,314 ------------- 0	37,855 ------------- 0	512,633 ------------- 0	57,574 ------------- 0
10LINDA WEINREB MEDICAL DIRECTOR, MCD ACO	(i) (ii)	322,318 ------------- 0	68,866 ------------- 0	13,382 ------------- 0	112,586 ------------- 0	37,107 ------------- 0	554,259 ------------- 0	68,866 ------------- 0
11MARK DICHTER VP, Medical Director for UM	(i) (ii)	312,294 ------------- 0	50,654 ------------- 0	3,564 ------------- 0	108,110 ------------- 0	34,557 ------------- 0	509,179 ------------- 0	0 ------------- 0
12MARY RITTER SVP, CHIEF STRTGY & GOVT. PROG	(i) (ii)	362,802 ------------- 0	92,664 ------------- 0	28,277 ------------- 0	175,757 ------------- 0	38,644 ------------- 0	698,144 ------------- 0	115,421 ------------- 0
13MATTHEW HERNDON SVP, Chief State Prog. Officer	(i) (ii)	305,515 ------------- 0	0 ------------- 0	3,074 ------------- 0	145,769 ------------- 0	27,405 ------------- 0	481,763 ------------- 0	0 ------------- 0
14RANDI BERKOWITZ VP, Medical Director	(i) (ii)	327,063 ------------- 0	31,669 ------------- 0	1,242 ------------- 0	118,538 ------------- 0	33,709 ------------- 0	512,221 ------------- 0	0 ------------- 0
15RICHARD P BURKE PRESIDENT & CEO	(i) (ii)	892,714 ------------- 0	358,020 ------------- 0	169,057 ------------- 0	692,878 ------------- 0	45,531 ------------- 0	2,158,200 ------------- 0	500,053 ------------- 0
16TODD BAILEY SVP, CHIEF FINANCIAL OFFICER	(i) (ii)	462,481 ------------- 0	119,779 ------------- 0	24,972 ------------- 0	212,624 ------------- 0	8,535 ------------- 0	828,391 ------------- 0	140,113 ------------- 0

Schedule J (Form 990) 2022

Page 3

Part III

Supplemental Information

Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for any additional information.

Return Reference	Explanation
SCHEDULE J, PART I, LINE 3:	THE FCHP BOARD HAS THE AUTHORITY AND DISCRETION TO DETERMINE COMPENSATION OF THE SENIOR EXECUTIVES AND EXECUTIVE INCENTIVES. THE DISCRETION IS TYPICALLY EXERCISED THROUGH THE BOARD'S EXECUTIVE EVALUATION AND COMPENSATION COMMITTEE, WHICH HAS THE AUTHORITY TO DISCHARGE THE BOARD'S RESPONSIBILITIES FOR COMPENSATION AND EXECUTIVE INCENTIVES. HOWEVER, THE DISCRETIONARY COMPENSATION/INCENTIVES RECOMMENDED MUST BE WITHIN THE PARAMETERS OF THE STANDARDS THAT THE COMMITTEE HAS ESTABLISHED AND NEEDS TO BE CONSISTENT WITH THE IRS STANDARDS OF REASONABLENESS FOR SUCH INCENTIVES PROVIDED TO NONPROFIT EXECUTIVES.
SCHEDULE J, PART I, LINE 4B:	SEE ALSO PART I, LINE 7 SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN FCHP OFFERED A SUPPLEMENTAL EXECUTIVE RETIREMENT 457(F) PLAN (SERP), THAT COVERED CERTAIN EXECUTIVES IN THE ORGANIZATION. PARTICIPANTS IN THIS PLAN VESTED ANNUALLY AND RECEIVED DISTRIBUTIONS ONCE VESTING REQUIREMENTS WERE MET. SERP CONTRIBUTIONS COULD BE MADE ON BEHALF OF AN EMPLOYEE WHO WAS THE PRESIDENT AND CHIEF EXECUTIVE OFFICER, THE DIVISION PRESIDENT, SENIOR CARE SERVICES, AN EXECUTIVE OR SENIOR VICE PRESIDENT. IN ADDITION, CONTRIBUTIONS COULD BE MADE ON BEHALF OF ANY EMPLOYEE WHO WAS DESIGNATED AS ELIGIBLE FOR A PLAN BY THE BOARD AT ITS DISCRETION. THE 457 (F) PLAN SERP WAS FROZEN ON DECEMBER 31, 2021 AND THE BOARD DECIDED IT WOULD NO LONGER MAKE DISCRETIONARY CONTRIBUTIONS ON BEHALF OF ANY PARTICIPANT FOR THE YEARS 2018 - 2021. IN 2022, THE FOLLOWING INDIVIDUALS LISTED IN SCHEDULE J, PART II RECEIVED DISTRUBTIONS FROM THE 457 (F) SERP PLAN FOR YEARS 2018 - 2021. AMOUNTS PAID UNDER THE PLAN ARE INCLUDED IN SCHEDULE J, PART II, COLUMN (B) (III) AND ARE LISTED BELOW. AMOUNTS DEFERRED IN PRIOR YEARS WERE INCLUDED IN SCHEDULE J, PART II, COLUMN (C). CONTRIBUTIONS THAT WERE PREVIOUSLY REPORTED ON A PRIOR FORM 990 AND ARE PAID OUT IN THE CURRENT YEAR ARE REPORTED IN SCHEDULE J, PART II, COLUMN (F). NAME AMOUNT VESTED AND PAID RICHARD P. BURKE 142,033 TODD BAILEY 20,334 CHRISTINE CASSIDY 19,458 JAMES GENTILE 19,743 JILL LEBOW 24,025 MARY RITTER 22,757 FCHP ESTABLISHED A NEW NON-QUALIFIED DEFERRED COMPENSATION PLAN (THE "PLAN"), WHICH PROVIDES DISCRETIONARY INCENTIVE AWARDS TO EXECUTIVE OFFICERS AND OTHER SELECTED EMPLOYEES OF THE COMPANY TO INCENTIVIZE THEM TO REINFORCE CRITICAL LONG-TERM STRATEGIC GOALS AND ENCOURAGE SUSTAINED YEAR-TO-YEAR PERFORMANCE RELATIVE TO KEY FINANCIAL AND STRATEGIC INDICATORS. THE PLAN REPLACED THE AFOREMENTIONED 457 (F) PLAN (SERP), EFFECTIVE JANUARY 1, 2022. THIS LONG-TERM INCENTIVE PLAN QUALIFIES AS 457(F) SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN. THE PARTICIPANT WILL RECEIVE A CASH DISTRIBUTION AFTER THE END OF THE APPLICABLE PERFORMANCE PERIOD, IN MARCH OR APRIL OF THE CALENDAR YEAR FOLLOWING THE LAST DAY OF THE APPLICABLE PERFORMANCE PERIOD. IF THE PARTICIPANT'S EMPLOYMENT TERMINATES OR HAS A SEPARATION FROM SERVICE FOR ANY REASON OTHER THAN IN THE EVENT OF DEATH, DISABILITY, RETIREMENT OR CHANGE OF CONTROL PRIOR TO THE DATE OF THE CASH DISTRIBUTION, THE PARTICIPANT WILL NOT BE ELIGIBLE TO RECEIVE PAYMENT AND THE AWARD WILL BE CANCELLED AND FORFEITED IN ITS ENTIRETY. AMOUNTS DEFERRED UNDER THE PLAN ARE INCLUDED IN SCHEDULE J, PART II, COLUMN (C). THESE AMOUNTS WOULD NOT BE CONSIDERED VESTED AS OF 12/31/2022, AS THE PLAN'S FIRST PERFORMANCE PERIOD IS EFFECTIVE JANUARY 1, 2022 THROUGH DECEMBER 31, 2024.
SCHEDULE J, PART I, LINE 7:	CORPORATE INCENTIVE PLAN FCHP HAS A CORPORATE INCENTIVE PLAN FOR CERTAIN EMPLOYEES TO REWARD ACHIEVEMENT OF FINANCIAL AND STRATEGIC GOALS OF THE ORGANIZATION. ON AN ANNUAL BASIS, THE ORGANIZATION PAYS ELIGIBLE PARTICIPANTS THEIR INCENTIVE COMPENSATION, PART OF WHICH IS BASED OFF OPERATING INCOME TARGETS. EMPLOYEES MUST BE EMPLOYED IN GOOD STANDING THROUGH THE TIME OF PAYOUT. INCENTIVE PAYMENTS ARE TYPICALLY PAID OUT THE FIRST PAY CYCLE IN APRIL FOR THE PRECEEDING YEAR. IN 2022 CERTAIN EMPLOYEES LISTED IN SCHEDULE J, PART II PARTICIPATED IN THE PLAN. AMOUNTS PAID BY THE ORGANIZATION UNDER THE PLAN ARE INCLUDED IN SCHEDULE J, PART II, COLUMN B(II). CONTRIBUTIONS THAT WERE PREVIOUSLY REPORTED ON A PRIOR FORM 990 IN SCHEDULE J, PART II, COLUMN (C) ARE PAID OUT IN THE CURRENT YEAR AND ARE REPORTED IN SCHEDULE J, PART II, COLUMN (F). SEE ALSO SCHEDULE J, PART 1, LINE 3.
SCHEDULE J, PART I, LINES 8 AND 9:	MATTHEW HERNDON, SVP, CHIEF STATE PROGRAM OFFICER, HAS AN INITIAL EMPLOYMENT CONTRACT THAT DESCRIBES HIS INITIAL COMPENSATION AND BENEFITS.
SCHEDULE J, PART I, LINE 1A	FCHP HAS A GIFT CARD POLICY THAT THE COMPANY PAYS ALL APPLICABLE TAXES ON BEHALF OF THE EMPLOYEE. THE VALUE OF THE GIFT CARD IS INCLUDED IN THE EMPLOYEE'S TAXABLE INCOME. THIS POLICY APPLIES TO ALL FCHP EMPLOYEES. IN 2022, THE FOLLOWING INDIVIDUALS LISTED IN SCHEDULE J, PART II RECEIVED GIFT CARDS FROM FCHP DURING THE YEAR. NAME AMOUNT PAID EMILY WEST $100 CHRISTINE CASSIDY $100 DAVID BRUMLEY MD $50

Schedule J (Form 990) 2022

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990)

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 990-EZ or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.
MediumBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2021

Open to Public
Inspection

Name of the organization

FALLON COMMUNITY HEALTH PLAN INC

Employer identification number

23-7442369

Return Reference	Explanation
ORGANIZATION MISSION AND PROGRAM ACTIVITIES	FORM 990, PART I LINE 1 ORGANIZATION MISSION AND PROGRAM ACTIVITIES FOUNDED IN 1977, FALLON COMMUNITY HEALTH PLAN, INC. ("FALLON HEALTH") IS A LEADING HEALTH CARE SERVICES ORGANIZATION WITH A MISSION TO PROVIDE CARE, COVERAGE AND SERVICES DESIGNED TO MEET THE UNIQUE AND CHANGING NEEDS OF THE COMMUNITIES IT SERVES. IN ADDITION TO OFFERING INNOVATIVE HEALTH INSURANCE SOLUTIONS, FALLON HEALTH EXCELS AT CREATING UNIQUE HEALTH CARE PROGRAMS AND SERVICES THAT PROVIDE COORDINATED, INTEGRATED CARE FOR OLDER ADULTS AND INDIVIDUALS WITH COMPLEX HEALTH NEEDS. WITH A PREDOMINANT FOCUS ON GOVERNMENT SPONSORED HEALTH INSURANCE PROGRAMS, FALLON HEALTH'S PRODUCT PORTFOLIO INCLUDES A VARIETY OF MEDICAID AND MEDICARE ADVANTAGE PLANS. AS A PROVIDER OF CARE, FALLON OFFERS A PROGRAM OF ALL-INCLUSIVE CARE FOR THE ELDERLY.
FORM 990, PART III, LINE 4A	GOVERNMENT PROGRAMS FROM ITS VERY START IN 1977, FALLON HEALTH HAS ALWAYS BEEN COMMITTED TO SERVING THE HEALTH CARE NEEDS OF INDIVIDUALS ENROLLED IN MEDICARE AND MEDICAID PROGRAMS. IT HAS WORKED TO EXPAND THOSE OFFERINGS OVER THE YEARS, ANNOUNCING IN 2021 THAT IT WOULD PRIMARILY FOCUS ITS RESOURCES ON GOVERNMENT-SPONSORED HEALTH INSURANCE PROGRAMS. LISTED BELOW IS THE COMPLETE LIST OF THE GOVERNMENT-SPONSORED PROGRAMS FALLON HEALTH OFFERED IN 2022 IN MASSACHUSETTS AND, THROUGH FALLON HEALTH WEINBERG, IN NEW YORK. . MEDICARE ADVANTAGE AND MEDICARE SUPPLEMENT (MASSACHUSETTS) . MASSHEALTH ACCOUNTABLE CARE ORGANIZATION PARTNERSHIP PLANS (MASSACHUSETTS) . MEDICARE ADVANTAGE SPECIAL NEEDS PLAN AND SENIOR CARE OPTIONS (MASSACHUSETTS) . PROGRAM OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) (MASSACHUSETTS AND NEW YORK) . SUBSIDIZED, LIMITED-NETWORK PLAN (MASSACHUSETTS) . MANAGED LONG TERM CARE (MLTC) PLAN (NEW YORK) THESE PROGRAMS ENABLE FALLON HEALTH TO SERVE MEMBERS OF ALL AGES, AT ALL INCOME LEVELS AND WITH ALL TYPES OF HEALTH NEEDS. THERE ARE SEVERAL NOTABLE FACTS WHEN IT COMES TO FALLON HEALTH'S HISTORY IN GOVERNMENT PROGRAMS: . IN 1979, FALLON HEALTH RECEIVED THE FIRST CONTRACT IN MASSACHUSETTS TO COVER MEDICAID BENEFICIARIES. . IN 1980, FALLON HEALTH WAS THE FIRST HEALTH PLAN IN THE COUNTRY TO OFFER A MEDICARE ADVANTAGE PLAN. . IN 1995, FALLON HEALTH STARTED ITS PACE PROGRAM IN MASSACHUSETTS, KNOWN TODAY AS SUMMIT ELDERCARE. IT IS THE LARGEST PACE PROGRAM IN NEW ENGLAND AND INCLUDES SIX PACE CENTERS - FIVE IN MASSACHUSETTS AND ONE IN WESTERN NEW YORK. . IN 2010, FALLON HEALTH LAUNCHED NAVICARE, A MEDICARE ADVANTAGE SPECIAL NEEDS PLAN AND SENIOR CARE OPTIONS PROGRAM IN MASSACHUSETTS. . IN 2017, FALLON HEALTH FORMED MASSHEALTH ACCOUNTABLE CARE ORGANIZATION PARTNERSHIP PLANS WITH THE FOLLOWING PROVIDER GROUPS: . BERKSHIRE HEALTH SYSTEMS AND COMMUNITY HEALTH PROGRAMS . RELIANT MEDICAL GROUP . WELLFORCE (NOW TUFTS MEDICINE) AND ITS PROVIDER ORGANIZATIONS
FORM 990, PART III, LINE 4B	COMMERCIAL PRODUCTS AND SERVICES ON MARCH 31, 2021, FALLON HEALTH ANNOUNCED THAT IT WOULD BEGIN PRIMARILY FOCUSING ITS RESOURCES ON SUPPORTING THE HEALTH CARE NEEDS OF INDIVIDUALS ENROLLED IN GOVERNMENT-SPONSORED HEALTH INSURANCE PROGRAMS. THESE ACTIONS RESULTED IN THE COMPLETE WITHDRAWAL FROM THE COMMERCIAL MARKET OF FALLON HEALTH'S SELECT CARE AND DIRECT CARE HMO PRODUCTS BY THE END OF AUGUST 2022. FALLON HEALTH CONTINUES TO SELL ITS COMMUNITY CARE PRODUCT ON THE HEALTH CONNECTOR. THE PRODUCT IS AVAILABLE TO INDIVIDUALS AND SMALL GROUPS IN MIDDLESEX COUNTY, PARTS OF NORFOLK AND WORCESTER COUNTIES, AND IN ONE TOWN IN BRISTOL COUNTY (MANSFIELD).
FORM 990, PART III, LINE 4C	COMMUNITY GIVING FALLON HEALTH'S COMMUNITY BENEFITS PROGRAM IS RUN IN ACCORDANCE WITH THE MASS. ATTORNEY GENERAL'S GUIDELINES FOR HEALTH MAINENANCE ORGANIZATIONS. OUR COMMITMENT TO THE ORGANIZATION'S MISSION GUIDES US IN THE WORK WE DO IN SUPPORT OF THE DIVERSE COMMUNITIES WE SERVE. THE GOALS OF THE FALLON HEALTH COMMUNITY BENEFITS PROGRAM ARE TO: . SUPPORT PROGRAMS THAT WILL IMPROVE THE HEALTH STATUS OF ECONOMICALLY UNDERSERVED OR AT-RISK POPULATIONS, CHILDREN, YOUTH AND ELDERS WITHIN OUR SERVICE AREA. . CONTINUE FALLON'S ROLE AS A HEALTH EDUCATOR BY PROVIDING RESOURCES, HOSTING HEALTH AND INFORMATION PROGRAMS AND BY BRINGING GENERAL INFORMATION TO THE PUBLIC THROUGH SPEAKING ENGAGEMENTS, PROGRAMS AND THE USE OF OUR COMMUNICATION PLATFORMS. . CONVENE KEY COMMUNITY STAKEHOLDERS, PROVIDERS, COMMUNITY-BASED ORGANIZATIONS AND INDIVIDUALS TO DISCUSS ESCALATING HEALTH ISSUES THAT HAVE A SIGNIFICANT EFFECT ON THE COMMUNITY'S POSITIVE HEALTH OUTCOMES AND OVERALL COST OF CARE. . WORK COLLABORATIVELY WITH OTHER HEALTH CARE PROVIDERS AND COMMUNITY-BASED ORGANIZATIONS TO DEVELOP AND IMPLEMENT PROGRAMS TARGETING UNDERSERVED OR AT-RISK POPULATIONS AS DETERMINED BY THE NEEDS OF EACH OF THE COMMUNITIES WE SERVE. . PARTNER WITH BUSINESSES, COMMUNITY-BASED ORGANIZATIONS AND LOCAL CITIES, TOWNS AND STATE AGENCIES TO DEVELOP, SUPPORT AND/OR IMPLEMENT COMMUNITY HEALTH IMPROVEMENT PLANS AND PROGRAMS THAT ARE IDENTIFIED THROUGH LOCAL COMMUNITY HEALTH ASSESSMENTS AND ADDRESS THE BARRIERS THAT IMPACT POSITIVE HEALTH OUTCOMES. . CONTINUE TO FIND WAYS TO DELIVER OR PROVIDE ACCESS TO CULTURALLY COMPETENT, HIGH-QUALITY, LOW-COST HEALTH CARE COVERAGE TO PEOPLE OF ANY AGE, RACE, ETHNICITY, RELIGION, ABILITY, SEXUAL ORIENTATION, GENDER IDENTITY, HEALTH STATUS AND INCOME LEVEL. IN 2022, OUR LONG-STANDING COMMITMENT TO THE COMMUNITIES WE SERVE WAS DEMONSTRATED IN A NUMBER OF WAYS, INCLUDING: . SPONSORING FOOD INSECURITY INITIATIVES WITH COMMUNITY PARTNERS INCLUDING HOCKEY CHECKS HUNGER (WORCESTER RAILERS) AND STRIKE OUT HUNGER (WORCESTER RED SOX) . AWARDING $150,000 IN COMMUNITY IMPACT GRANTS FOR PROJECTS TARGETING FOOD INSECURITY AND SOCIAL ISOLATION AMONG OLDER ADULTS . RAISING MORE THAN $64,000 TO BENEFIT THE UNITED WAY OF CENTRAL MASS.' ANNUAL CAMPAIGN (EMPLOYEES) . COMPLETING MORE THAN 12,000 HOURS OF COMMUNITY SERVICE (EMPLOYEES) FALLON HEALTH'S FUNDING PRIORITY AREAS AFTER A COMPREHENSIVE REVIEW OF THE FINDINGS OF THE 2021 GREATER WORCESTER COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA), THE IDENTIFIED OBJECTIVES AND STRATEGIES FROM THE GREATER WORCESTER COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP) COMPLETED IN 2022, AND A REVIEW OF THE CHNAS CONDUCTED IN BERKSHIRE COUNTY, GREATER LOWELL, METRO WEST, NORTHERN WORCESTER COUNTY, SOUTH SHORE AND WESTERN MASS., THE FOLLOWING RECOMMENDATIONS WERE PRESENTED AS THE FUNDING PRIORITIES FOR FALLON'S COMMUNITY BENEFITS PROGRAM FOR 2021-2023: . FOOD INSECURITY - TO HELP MAINTAIN FOOD ASSISTANCE PROGRAMS FOR THOSE AREAS OR POPULATIONS THAT ARE PARTICULARLY VULNERABLE TO FOOD INSECURITY. IN ADDITION TO TRADITIONAL RESOURCES, FALLON SUPPORTS NEW, INNOVATIVE PROGRAMMING. . HEALTH INITIATIVES FOR OLDER ADULTS - TO SUPPORT OLDER ADULTS THROUGH PROGRAMS THAT PROVIDE ACCESS TO CARE INCLUDING BEHAVIORAL HEALTH RESOURCES, SAFETY MEASURES IN THEIR HOMES AND COMMUNITIES, AND ACCESS TO FOOD AND UTILITIES. IN 2022, FALLON HEALTH DISTRIBUTED $1,280,924.70 TO PROGRAMS THAT MET THE GOALS OF FALLON'S COMMUNITY BENEFITS PROGRAM. THIS WAS ACCOMPLISHED BY CONTRIBUTING $494,546 OF COMMUNITY GRANTS AND PARTICIPATING IN OTHER PROGRAMS, INCLUDING DIRECT EXPENSES, LEVERAGED EXPENSES, STAFF VOLUNTEER TIME, AND PHILANTHROPIC INITIATIVES THROUGH CORPORATE SPONSORSHIPS, TOTALLING $786,378. FALLON HEALTH'S EMPLOYEES ARE ALSO ENCOURAGED TO VOLUNTEER IN THE COMMUNITY. AND EACH INDIVIDUAL IS PROVIDED EIGHT HOURS OF PAID WORK TIME TO DO SO. IN 2022, OUR EMPLOYEES LOGGED 12,300 HOURS OF COMMUNITY SERVICE WITH 676 HOURS OF THAT PUT TOWARDS FALLON HEALTH DRIVEN INITIATIVES. FALLON HEALTH ALSO GIVES BACK THROUGH CORPORATE GIVING AND GENEROUS EMPLOYEE DONATIONS IN 2022, EMPLOYEES USED APPROXIMATELY 161 HOURS TO SUPPORT THE UNITED WAY'S CAMPAIGN ACTIVITIES. THESE EFFORTS HELPED TO RAISE APPROXIMATELY $64,605. THE MAJORITY OF THESE FUNDS WERE DISTRIBUTED TO THE UNITED WAY OF CENTRAL MASS. THE REMAINING FUNDS WERE DISTRIBUTED TO THE UNITED WAY OF TRI-COUNTY, INC., UNITED WAY OF MASS. BAY & MERRIMACK VALLEY, THE UNITED WAY OF NORTH CENTRAL MASS., UNITED WAY OF SOUTH CENTRAL MASS., THE UNITED WAY OF GREATER FALL RIVER, BERKSHIRE COUNTY UNITED WAY, UNITED WAY OF FRANKLIN COUNTY, UNITED WAY OF GREATER PLYMOUTH COUNTY AND THE UNITED WAY OF PIONEER VALLEY. IN 2022, WE CONTINUED OUR FOCUS ON SUPPORTING FOOD PANTRIES TO FEED UNDERSERVED OR AT-RISK OLDER ADULTS, FAMILIES AND CHILDREN, INCLUDING THE HOCKOMOCK AREA YMCA, THE ELDER SERVICES OF THE BERKSHRIES, THE OPEN DOOR/CAPE ANN FOOD PANTRY AND THE BOYS & GIRLS CLUB OF WORCESTER. IN ADDITION, EMPLOYEES PROVIDED MEALS FOR 472 FAMILIES ACROSS OUR KEY SERVICE AREA WITH OUR FEED-A-FAMILY PROGRAM IN BERKSHIRE COUNTY, SPRINGFIELD, LEOMINSTER, LOWELL, WEBSTER AND WORCESTER TOTALING $28,320 IN FOOD DONATIONS. FOOD INSECURITY HAS LONG BEEN AN ISSUE NATIONALLY AND IN THE LOCAL COMMUNITY. FALLON HEALTH AND THE WORCESTER RED SOX PARTNERED TOGETHER TO RAISE CRITICAL FUNDS AND AWARENESS ON THE ISSUE. IN 2022, THE STRIKE OUT HUNGER CAMPAIGN CULMINATED IN A $50,000 DONATION TO THE WORCESTER COUNTY FOOD BANK. SIGNATURE HEALTH AND WELLNESS PROGRAMS ARE ALSO KEY TO OUR MISSION AT FALLON. IN 2022, WE REACHED 2,173 PEOPLE IN MASSACHUSETTS. THIS WAS ACHIEVED IN A VARIETY OF WAYS INCLUDING PROVIDING SCREENINGS AND WELLNESS PRESENTATIONS TO UNDERSERVED POPULATIONS.
FORM 990, PART VI, LINE 2	FAMILY OR BUSINESS RELATIONSHIP BETWEEN OFFICERS, DIRECTORS, AND KEY EMPLOYEES. FALLON HEALTH & LIFE ASSURANCE CO., INC. (FHLAC) IS A WHOLLY-OWNED SUBSIDIARY OF FCHP. THE FOLLOWING FCHP BOARD MEMBERS AND OFFICERS SERVED ON THE FHLAC BOARD OF DIRECTORS IN 2022: JAMES R. BUONOMO, JOHN B. DILL, ANN K. TRIPP (UNTIL JUNE 24, 2022), FREDERICK MISILO, ESQ., JANET S. RICO, DEBORAH C. ENOS, JOSEPH N. STOLBERG, CPA(STARTING JUNE 24, 2022), AND RICHARD P. BURKE (EX OFFICIO). ULTRABENEFITS, INC. (UBI) IS A WHOLLY-OWNED SUBSIDIARY OF FHLAC. THE FOLLOWING FCHP OFFICERS AND KEY EMPLOYEE SERVED ON THE UBI BOARD OF DIRECTORS IN 2022: RICHARD P. BURKE, JANIS LIEPINS, AND TODD BAILEY. GROUP INSURANCE SERVICE CENTER AGENCY, INC. (GISC AGENCY), IS A WHOLLY-OWNED SUBSIDIARY OF UBI. THE FOLLOWING FCHP OFFICERS AND KEY EMPLOYEES SERVED ON THE BOARD OF GISC AGENCY IN 2022: RICHARD P. BURKE, JANIS LIEPINS, AND TODD BAILEY.
FORM 990, PART VI, LINE 11B	THE PROCESS USED BY MANAGEMENT AND GOVERNING BODY TO REVIEW FORM 990 A DRAFT OF THE FORM 990 IS PREPARED BY FCHP AND REVIEWED BY ITS TAX CONSULTING FIRM. THE FINAL VERSION OF THE FORM 990 IS PROVIDED TO BOARD MEMBERS FOR REVIEW PRIOR TO FILING WITH THE IRS.
FORM 990, PART VI, LINE 12C	THE PROCESS USED TO MONITOR CONFLICTS OF INTEREST 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.
FORM 990, PART VI, LINES 15A & 15B	PROCESS OF DETERMINING COMPENSATION FOR CEO, TOP MANAGEMENT OFFICIALS, OFFICERS, AND KEY EMPLOYEES. 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 FCHP 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 2022, 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"), AND THE EXECUTIVE VICE PRESIDENT, AND SENIOR VICE PRESIDENT POSITIONS THAT REPORT DIRECTLY TO THE CEO ("EXECUTIVE GROUP"). IN 2022, 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 THE 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.
FORM 990, PART VI, LINES 18 AND 19	HOW DOCUMENTS ARE MADE AVAILABLE TO PUBLIC FCHP'S FORM 990 AND ANNUAL AUDITED FINANCIAL STATEMENTS ARE AVAILABLE TO THE GENERAL PUBLIC ON THE MASSACHUSETTS ATTORNEY GENERAL'S WEBSITE. FCHP'S 990, FINANCIAL STATEMENTS, GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND ANNUAL REPORT ARE ALSO PROVIDED UPON REQUEST.
FORM 990, PART VII, SECTION A, COLUMN A	NAME AND TITLE: THE FOLLOWING INDIVIDUAL'S TITLE CHANGED DURING THE YEAR: KRISTINE BOSTEK: FROM: VP, SUMMIT ELDERCARE AND FALLON HEALTH WEINBERG PACE, UNTIL 5/22. TO: SVP, PACE PROGRAMS, EFFECTIVE 5/22. DAVID BRUMLEY MD: FROM: INTERIM CHIEF MEDICAL OFFICER, UNTIL 5/22. TO: SVP AND CHIEF MEDICAL OFFICER, EFFECTIVE 5/22.

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990) 2021

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SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

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 (if applicable) 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
(1) FCHP NEW YORK LLC 10 CHESTNUT ST WORCESTER,MA01608 46-4193932	HEALTH CARE	NY	0	0	FCHP

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 entity?
(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	Yes	No
(1)FALLON TOTAL CARE INC 10 CHESTNUT STREET WORCESTER,MA01608 45-5591420	HEALTH CARE	MA	501(C)(3)	PF	FCHP	Yes
(2)FALLON HEALTH WEINBERG INC 2700 NORTH FOREST RD GETZVILLE,NY14068 16-1580245	HEALTH CARE	NY	501(C)(3)	10	FCHP	Yes

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2021

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	(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
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No	(k) Percentage ownership

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	(i) Section 512(b)(13) controlled entity?
(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	Yes	No
(1) FALLON HEALTH & LIFE ASSURANCE COinc 10 CHESTNUT STREET WORCESTER,MA01608 04-3169246	HEALTH INS.	MA	FCHP	C CORP	11,186,677	27,722,513	100.000 %	Yes
(2) ULTRABENEFITS INC 22 ELM STREET WORCESTER,MA01608 04-3525752	3RD PARTY ADM	MA	FHLAC	C CORP	7,397,318	5,093,842	100.000 %	Yes
(3) GISC INSurance AGENCY INC 22 ELM STREET WORCESTER,MA01608 04-3273688	INSURANCE AGENCY	MA	UBI	C CORP	0	0	100.000 %	Yes

Schedule R (Form 990) 2021

Page 3

Part V

Transactions With Related Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.

Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.

Yes

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, or (iv) rent from a controlled entity .....................

Yes

b Gift, grant, or capital contribution to related organization(s) ............................

c Gift, grant, or capital contribution from related organization(s) ............................

d Loans or loan guarantees to or for related organization(s) ............................

Yes

e Loans or loan guarantees by related organization(s) ............................

f Dividends from related organization(s) ............................

g Sale of assets to related organization(s) ............................

h Purchase of assets from related organization(s) ............................

i Exchange of assets with related organization(s) ............................

j Lease of facilities, equipment, or other assets to related organization(s) .......................

Yes

k Lease of facilities, equipment, or other assets from related organization(s) ......................

l Performance of services or membership or fundraising solicitations for related organization(s) .....................

Yes

m Performance of services or membership or fundraising solicitations by related organization(s) .................

Yes

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................

Yes

o Sharing of paid employees with related organization(s) ............................

Yes

p Reimbursement paid to related organization(s) for expenses ............................

q Reimbursement paid by related organization(s) for expenses ............................

Yes

r Other transfer of cash or property to related organization(s) ............................

s Other transfer of cash or property from related organization(s) ............................

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 related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved
(1) ULTRABENEFITS INC	A,J	67,718	CASH
(2) FALLON HEALTH & LIFE ASSURANCE CO INC	D	170,715	CASH
(3) ULTRABENEFITS INC	D	56,113	CASH
(4) FALLON HEALTH WEINBERG INC	L	1,484,819	CASH
(5) ULTRABENEFITS INC	L	144,000	CASH
(6) ULTRABENEFITS INC	M	51,246	CASH
(7) FALLON HEALTH & LIFE ASSURANCE CO INC	N, O	3,972,385	CASH

Schedule R (Form 990) 2021

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)	(e) Are all partners section 501(c)(3) organizations?		(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
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No	(k) Percentage ownership

Schedule R (Form 990) 2021

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R. See instructions.

Return Reference	Explanation

Schedule R (Form 990) 2021

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