Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for instructions and the latest information.
| (i) Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 10 above (see instructions)) | (iv) Is the organization listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
|
Total |
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Calendar year
(or fiscal year beginning in)
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(a) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | ||||||
| 2 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.... | ||||||
| 3 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | ||||||
| 4 | Total. Add lines 1 through 3 | ||||||
| 5 | The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f) .. | ||||||
| 6 | Public support. Subtract line 5 from line 4. | ||||||
Calendar year
(or fiscal year beginning in)
![]() |
(a) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | ||||||
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | ||||||
| 9 | Net income from unrelated business activities, whether or not the business is regularly carried on.. | ||||||
| 10 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.).. | ||||||
| 11 | Total support. Add lines 7 through 10 | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | 115,793 | 1,636,717 | 1,752,510 | |||
| 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 | 1,025,465 | 1,142,212 | 999,172 | 976,839 | 550,804 | 4,694,492 |
| 3 | Gross receipts from activities that are not an unrelated trade or business under section 513 ..... | ||||||
| 4 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf... | ||||||
| 5 | The value of services or facilities furnished by a governmental unit to the organization without charge | ||||||
| 6 | Total. Add lines 1 through 5 | 1,025,465 | 1,142,212 | 999,172 | 1,092,632 | 2,187,521 | 6,447,002 |
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons | ||||||
| b | Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year. | ||||||
| c | Add lines 7a and 7b.. | ||||||
| 8 | Public support. (Subtract line 7c from line 6.) | 6,447,002 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 1,025,465 | 1,142,212 | 999,172 | 1,092,632 | 2,187,521 | 6,447,002 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 169,304 | 188,858 | 125,680 | 86,851 | 186,090 | 756,783 |
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | 169,304 | 188,858 | 125,680 | 86,851 | 186,090 | 756,783 |
| 11 | Net income from unrelated business activities not included on line 10b, whether or not the business is regularly carried on. | ||||||
| 12 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) .. | 145,159 | 145,159 | ||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | 1,194,769 | 1,331,070 | 1,124,852 | 1,324,642 | 2,373,611 | 7,348,944 |
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
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| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
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| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e |
Discount claimed for blockage or other factors (explain in detail in Part VI): |
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| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 0.015 of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by 0.035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | 1 | |
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
2 | |
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | 3 | |
| 4 Amounts paid to acquire exempt-use assets | 4 | |
| 5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI) | 5 | |
| 6 Other distributions (describe in Part VI). See instructions | 6 | |
| 7Total annual distributions. Add lines 1 through 6. | 7 | |
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
8 | |
| 9 Distributable amount for 2021 from Section C, line 6 | 9 | |
| 10 Line 8 amount divided by Line 9 amount | 10 | |
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2021 |
(iii) Distributable Amount for 2021 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2021 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2021 (reasonable cause required-- explain in Part VI). See instructions. |
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| 3 Excess distributions carryover, if any, to 2021: | ||||
| a From 2016....... | ||||
| b From 2017....... | ||||
| c From 2018....... | ||||
| d From 2019....... | ||||
| e From 2020....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2021 distributable amount | ||||
|
i
Carryover from 2016 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from line 3f. | ||||
| 4Distributions for 2021 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2021 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from line 4. | ||||
|
5
Remaining underdistributions for years prior to 2021, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
6
Remaining underdistributions for 2021. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions. |
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7 Excess distributions carryover to 2022. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2017..... | ||||
| b Excess from 2018..... | ||||
| c Excess from 2019..... | ||||
| d Excess from 2020..... | ||||
| e Excess from 2021..... | ||||
| Facts And Circumstances Test |
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| Return Reference | Explanation |
|---|---|
| PART III, LINE 12 | PPP LOAN FORGIVENESS AND OTHER 145,159 |
| Software ID: | |
| Software Version: |
Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| FORM 990 - ORGANIZATION'S MISSION | THE MISSION OF ACCESS HEALTH IS TO OFFER AN INTEGRATED COMMUNITY-BASED HEALTH IMPROVEMENT PROGRAM FOR THOSE RESIDENTS WHO OTHERWISE WOULD NOT RECEIVE SERVICES. THE VISION FOR ACCESS HEALTH IS TO PROVIDE ACCESS TO APPROPRIATE HEALTH CARE THROUGH THE EFFECTIVE USE OF COMMUNITY RESOURCES. |
| FORM 990, PAGE 2, PART III, LINE 4B | MUSKEGON COMMUNITY HEALTH INNOVATION REGION (CHIR) THE COMMUNITY HEALTH INNOVATION REGION (CHIR) IS A UNIQUE MODEL FOR IMPROVING THE WELLBEING OF A REGION AND REDUCING UNNECCESSARY MEDICAL COSTS THROUGH COLLABORATION AND SYSTEMS CHANGE. THE CHIR ENGAGES A BROAD GROUP OF STAKEHOLDERS TO IDENTIFY AND ADDRESS FACTORS THAT AFFECT RESIDENT'S HEALTH, SUCH AS HOUSING, TRANSPORTATION, AND FOOD INSECURITY, AS WELL AS ACCESS TO HIGH-QUALITY MEDICAL CARE. THE CHIR MODEL CREATES A NEUTRAL SPACE FOR PARTNERS TO UNITE AROUND A COMMON VISION, ALIGNING THEIR OBJECTIVES AND SERVICES TO MEET THE NEEDS OF THE COMMUNITY. THE RESULT IS A COMMUNITY THAT IS PURPOSEFUL IN ITS RESPONSE TO RESIDENTS' NEEDS, CREATING CONDITIONS THAT MEANINGFULLY SUPPORT AN INDIVIDUAL'S ABILITY TO HAVE A HIGHER, MORE PRODUCTIVE QUALITY OF LIFE. SERVED APPROXIMATELY 5,000 MEMBERS IN THE CHIR PROGRAM. |
| FORM 990, PAGE 2, PART III, LINE 4D | ACCESS-MERCY HEALTH THE ORGANIZATION OPERATED A TWO-YEAR PILOT CARE COORDINATION PROGRAM TO MANAGE THE CARE OF MERCY HEALTHS CHARITABLE CARE POPULATION. WITHIN THIS PILOT, PATIENTS WERE ENROLLED IN A COVERAGE PROGRAM THAT PROVIDED A COORDINATED APPROACH TO CARE THAT ALLOWED PARTICIPANTS TO APPROPRIATELY ACCESS MERCY HEALTH SERVICES INCLUDING PRIMARY CARE, LABORATORY SERVICES, AND PREVENTION CARE. THE PHASED IMPLEMENTATION APPROACH CONSISTED OF AN INITIAL LAUNCH IN THE IN THE MUSKEGON MERCY HEALTH CATCHMENT AREA, WHERE THE INFRASTRUCTURE ALREADY EXISTED, FOLLOWED BY A LAUNCH IN GRAND RAPIDS SAINT MARYS MERCY HEALTH CATCHMENT AREA. THIS ALLOWED FOR THE FOUNDATIONAL REFINEMENT OF CORE PROGRAM ELEMENTS WHILE BUILDING THE INFRASTRUCTURE AND ASSESSING THE SIMILARITIES AND DIFFERENCES BETWEEN THE MUSKEGON AND GRAND RAPIDS POPULATIONS. THE PROGRAM ENDED IN JULY 2021. COMMUNITY BENEFIT BOARD INITIATIVE (CBBI) THE ORGANIZATION IS THE SUBRECIPIENT OF A MERCY HEALTH COMMUNITY GRANT PROGRAM T SUPPORT THE MUSKEGON HEIGHTS ECONOMIC INNOVATION PROJECT. THE PROJECT PRIMARILY SERVICES MUSKEGON HEIGHTS, ADDRESSING PRIORITY AREAS OF EMPLOYMENT AND INCOME. THE FUNDING IS USED FOR PLANNING AND INITIAL IMPLEMENTATION OF THE MUSKEGON HEIGHTS ECONOMIC OPPORTUNITY INITIATIVE TO EXPAND ACCESS TO EDUCATIONAL AND JOB TRAINING, PROMOTE JOB READINESS, AND ALLEVIATE POVERTY AND RACIAL DISPARITY. HEALTH EQUITY THE ORGANIZATION IS A SUBRECIPIENT OF A HEALTH EQUITY GRANT FROM MICHIGAN PUBLIC HEALTH INSTITUTE TO REDUCE AND ELIMINATE COVID-19 INEQUITIES IN IMPACTED AND AT-RISK POPULATIONS. THE ORGANIZATIONS ROLE AS THE BACKBONE ORGANIZATION (BBO) IS TO CREATE A REGIONAL HEALTH EQUITY COUNCIL COMPRISED OF RESIDENT AND COMMUNITY ORGANIZATIONS ACTIVELY ENGAGES WITH MICHIGANS FIVE MINORITY POPULATIONS. THE HEALTH EQUITY COUNCIL, WITH SUPPORT OF THE BBO, DEVELOPS AND IMPLEMENTS AN ACTION PLAN TO ADDRESS AND REDUCE COMMUNITY PRIORITY RISK FACTORS AND NEEDS RELATED TO COVID-19 AND OTHER ROOT CAUSES OF HEALTH INEQUITY IN THE REGION. SERVED APPROXIMATELY 9 MEMBERS UNDER THE HEALTH EQUITY PROGRAM. BLUE CROSS BLUE SHIELD THE ORGANIZATION PROVIDES SERVICES FOR A THIRTEEN-MONTH PILOT TO INCORPORATE ENGAGEMENT, CARE MANAGEMENT, HEALTH COACHING, AND COMMUNITY ALIGNMENT PROCESSES TO BRING COMMUNITY HEALTH IMPROVEMENT (CHI) PROCESSES TO TWO DEFINED POPULATIONS: PRACTICE BASED POPULATION, WHICH ARE PRIMARY CARE MEDICAL HOME PATIENTS, AND PLACE BASED POPULATION, WHICH HAS A PRIMARY FOCUS ON THE SOUTH HEIGHTS RESILIENCE ZONE LOCATED IN MUSKEGON HEIGHTS, MI. WITHIN THIS POPULATION, THE PILOT WILL ADDRESS BARRIERS TO HEALTH IMPROVEMENT BY ADDRESSING SOCIAL COHESION, HEALTH IMPROVEMENT AND LIFE-LONG SUCCESS FOR ZONE RESIDENTS. THIS PROGRAM ENDED JULY 2022. CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC) THE ORGANIZATION WAS THE SUBRECIPIENT OF A CDC FOUNDATION GRANT TO SUPPORT PARTNERING WITH NATIONAL ORGANIZATIONS AND COMMUNITY-BASED ORGANIZATIONS TO INCREASE VACCINATION COVERAGE ACROSS DIFFERENT RACIAL AND ETHNIC ADULT POPULATIONS CURRENTLY EXPERIENCING DISPARITIES. THE ACTIVITIES PERFORMED BY THE ORGANIZATION SUPPORTED EFFORTS TO INCREASE INFLUENZA AND COVID-19 VACCINE CONFIDENCE AND UPTAKE FOR ADULTS IN RACIAL AND/OR ETHNIC POPULATIONS EXPERIENCING DISPARITIES IN THE UNITED STATES. SERVED APPROXIMATELY 4,000 MEMBERS IN THE CDC PROGRAM. |
| FORM 990, PAGE 6, PART VI, LINE 3 | THE ORGANIZATION PAYS ADVANCED MEDICAL & BEHAVIORAL HEALTH SERVICES, INC. FOR CONTRACT SERVICES IN WHICH THE CORPORATION PROVIDES THE SERVICES OF JEFF FORTENBACHER AS EXECUTIVE DIRECTOR TO ACCESS HEALTH INC. AS SUCH, THE ORGANIZATION DELEGATES CONTROL OVER MANAGEMENT DUTIES TO ADVANCED MEDICAL & BEHAVIOR HEALTH SERVICES, INC. THE AMOUNT PAID FOR THOSE SERVICES IS DISCLOSED ON SCHEDULE J AND IN PART VII. |
| FORM 990, PAGE 6, PART VI, LINE 11B | THE FORM 990 IS REVIEWED BY THE FINANCE COMMITTEE AND IS MADE AVAILABLE TO ALL BOARD MEMBERS. |
| FORM 990, PAGE 6, PART VI, LINE 12C | CONFLICT OF INTEREST IS MONITORED BY A REVIEW OF ALL FINANCIAL TRANSACTIONS BY TOP MANAGEMENT; BOARD MEMBERS ARE REQUIRED TO RECLUSE THEMSELVES FROM VOTING ON MATTERS THAT RELATE TO CONTRACTS BETWEEN ACCESS HEALTH AND THEIR EMPLOYER. ANNUAL CONFLICT OF INTEREST DISCLOSURES ARE REQUIRED BY ALL BOARD MEMBERS AND SENIOR MANAGEMENT AND EACH EMPLOYEE AND CONTRACTOR IS REQUIRED TO DISCLOSE ANY POSSIBLE CONFLICTS OF INTEREST OR TO NOT ENGAGE IN ANY. |
| FORM 990, PAGE 6, PART VI, LINE 15A | THE BOARD OF DIRECTORS DETERMINED THE COMPENSATION TO PAY FOR THE SERVICES OF THE EXECUTIVE DIRECTOR AS A LEASED EMPLOYEE. THE EXECUTIVE DIRECTOR PROPOSES COMPENSATION FOR ALL OTHER LEASED EMPLOYEES, AND THE BOARD OF DIRECTORS APPROVES. |
| FORM 990, PAGE 6, PART VI, LINE 15B | THE BOARD OF DIRECTORS DETERMINED THE COMPENSATION TO PAY FOR THE SERVICES OF THE EXECUTIVE DIRECTOR AS A LEASED EMPLOYEE. THE EXECUTIVE DIRECTOR PROPOSES COMPENSATION FOR ALL OTHER LEASED EMPLOYEES, AND THE BOARD OF DIRECTORS APPROVES. |
| FORM 990, PAGE 6, PART VI, LINE 19 | THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. |
| FORM 990, PART VII | THE ORGANIZATION PAYS ADVANCED MEDICAL & BEHAVIORAL HEALTH SERVICES, INC. FOR CONTRACT PERSONNEL SERVICES FOR JEFF FORTENBACHER AS EXECUTIVE DIRECTOR. THE AMOUNT PAID FOR THOSE SERVICES IS DISCLOSED IN PART VII AND PART IX, LINE 5. |
| FORM 990, PART IX, LINE 11G | CONTRACTED SERVICES 334,717 197 0 OTHER PROFESSIONAL FEES 15,891 10,870 0 TOTAL 350,608 11,067 0 |
| FORM 990, PART XI, LINE 9 | PRIOR PERIOD ADJUSTMENT IS TO ACCOUNT FOR THE PRESENTATION OF PRIOR PERIOD NET ASSETS WITH DONOR RESTRICTION. |
| Software ID: | |
| Software Version: |